Use of acute hospital inpatient services by nursing home residents is a sizeable and poorly defined source of Medicare expenditure. A better defintiion of the magnitude and predictors of this utilization of hospitals should provide a basis for developing and evaluating cost-saving alternative strategies. Toward this end, the objectives of this one year research proposal are to compute rates, costs and predictors of hospitalization of elderly nursing home residents in a well-defined community, Monroe County, New York. Pre-collected, largely computerized utilization review data which are maintained by the Monroe County Long-Term Care Program (ACCESS) on all nursing home residents in the county will be utilized for the analyses. The data include a wide range of measures of functional and medical status of nursing home residents as well as selected descriptors of nursing homes, all of which will be considered in deriving predictor equations. The study will analyze the experiences of the populations residing in both skilled nursing facilities (SNF) snd intermediate care facilities (ICF) for the calendar year 1982 during which there were approximately 850 and 300 hospitalizations from SNFs and ICFs respectively. Special attention will be focused upon some two hundred persons with multiple hospital admissions who are likely to be the highest cost patients. Because the study is based upon functional and medical parameters which are in widespread use for utilization review in long-term care patient populations it is anticipated that findings from this project will be generalizable to other settings. Based upon methodology developed in execution of this project, a second phase of study will be designed to focus on use of acute hospitals by ACCESS long-term care patients living in the community in their own homes or in sheltered housing. This will be developed and submitted for continuation funding for the following year.